Cardiac Pathology

Question 1

What is the most common type of heart disease and leading cause of death?

Answer 1

Coronary Artery Disease

Question 2

Increasing age, Male gender, Hypertension, Hyperlipedemia, Cigarette Smoking & Diabetes are risk factors for what?

Answer 2

Coronary Artery Disease/Ischemic Heart Disease

Question 3

List the most common sites of atherosclerotic disease in the heart in increasing order

Answer 3

LAD > RCA > LCX > LCA

Question 4

Distinguish a R. vs. L. dominant heart

Answer 4

R. Dominant - Posterior descending artery is supplied by R. coronary A.

L. Dominant - Posterior descending artery is supplied by L. circumflex A

Question 5

Substernal chest pain (crushing, stabbing, squeexing); pain that radiates to neck jaw or schoulder; Rapid, weak pulse; profuse sweating; nauseas & vomiting; dyspnea and discomfort are all classic clinical features of what?

Answer 5

Myocardial Infarction

Question 6

Causes of Coronary Artery Disease

Answer 6

Atherosclerosis
Coronary artery emboli
Myocardial vessel inflammation (vasculitis)
Vessel spasm

Question 7

What is the most sensitive and specific biomarkers of myocardial damage

Answer 7

Cardiac troponin T and I

They are proteins that regulate calcium mediated contraction of cardiac muscle

Question 8

What proteins are used to determine myocardial damage but are not gold standard

Answer 8

Creatine kinase MB heterodimer - is sensitive but not specific for cardiac injury

Myoglobin - It is nonspecific for cardiac injury

Question 9

elevation of cardiac enzymes in a typical assay is seen as early as _____, _____ returns to normal after 48 to 72 hours and troponin remains elevated for _____

Answer 9

3 hours
CK-MB
>5 days

Question 10

Occlusion of the LAD causes infarction of what?

Answer 10

Apex, LV anterior wall & anterior 2/3 of septum

Question 11

Occlusion of the circumflex A. causes infarction of what?

Answer 11

L. ventricular lateral wall

Question 12

Occlusion of the RCA causes infarction of what?

Answer 12

RV, LV posterior wall, posterior 1/3 of septum

Question 13

At what point are the following irreversible histologic changes seen in a MI seen:

1. Slight waviness of fibers
2. Very early coagulation necrosis and edema
3. Coagulation necrosis increases with loss of nuclei, hypereosiniophilic
4. Neutrophil infiltrate, yellow tan infarct
5. Presence of Macrophages
6. Scar tissue is being laid down
7. Scarring complete and consists of a dense scar

Answer 13

1. 30 mins - 4 hrs
2. 4 hrs - 12 hrs
3. 12 hrs - 24 hrs
4. 1 - 3 days
5. 3 days - 1 week
6. 1-2 weeks
7. 2 months

Question 14

What is the time frame and characteristics of the early complications of an MI

Answer 14

First 24 hours

• Life threatening arrhythmias (V fib)
• Contractile/Cardiogenic Dysfunction (Shock)

Question 15

What is the time frame and characteristics of the intermediate complications of an MI

Answer 15

2-4 days and up to 2 weeks

• Rupture: free wall, septum and papillary muscles
• Acute fibrinous pericarditis

Question 16

What is the time frame and characteristics of the late complications of an MI

Answer 16

After 2 weeks

• Chronic pericarditis (Dressler Syndrome)
• Ventricular aneurysm
• Continued risk of heart failure and life threatening arrhythmia

Question 17

What is the number one cause of death due to an MI & when does it typically occur

Answer 17

Arrhythmias, specifically ventricular fibrillation w/in 1 hour of onset

Question 18

What is it called when there’s a rupture of the free wall, leading to blood accumulation in the pericardial space. This makes it hard for the heart to adequately fill during diastole because of the pressure of the blood in the pericardial sac and can ultimately lead to hemodynamic collapse

Answer 18

Acute pericardial tamponade

Question 19

Increase age, first MI, absence of LV hypertrophy are all risk factors for what

Answer 19

Myocardial rupture - transmural infarct 2-4 post MI

Question 20

What is Dressler Syndrome & it’s symptoms

Answer 20

Chronic fibrinous pericarditis due to immune reaction to myocardial proteins in blood.

Symptoms include fever, pleuritic pain, pericardial effusion

Question 21

What is Chronic ischemic heart disease (IHD)

Answer 21

A state of heart dysfunction as a result of late complication of a MI which can lead to congestive heart failure and sudden cardiac death

Question 22

Transient, often recurrent chest pain induced by myocardial ischemia but insufficient to induce myocardial infarction is known as what

Answer 22

Angina Pectoris

Question 23

What are the three clinical variants of Angina

Answer 23

1. Stable Angina
2. Prinzmetal Variant Angina
3. Unstable Angina

Question 24

What causes the pain in Angina Pectoris

Answer 24

Lack of oxygen to tissues leads to the release of adenosine and bradykinin causing pain

Question 25

``` Stable angina is characterized by: Stenotic occlusion of _____ arteries - Clinical manifestations include _______ - Relieved by _______ - Induced by _______ ```

Answer 25

Coronary arteries - Substernal pressure, squeezing, burning - Relieved by rest or vasodilators - Induced by physical activity

Question 26

_______ variant angina is characterized by: - Episodic _______ - Relieved by _______ - Unrelated to physical activity, HR or BP

Answer 26

Prinzmetal variant angina is characterized by: - Episodic coronary artery spasm - Relieved by vasodilators - Unrelated to physical activity, HR or BP

Question 27

Define unstable angina

Answer 27

Angina which is present at rest or angina that increases in frequency or duration (crescendo pattern)

Question 28

STEMI corresponds pathologically to what

Answer 28

Transmural infarction (All layers of heart) & ST elevation in EKG

Question 29

Since NSTEMI and unstable angina both cause partial occlusion of coronary vessels, how can they be distinguished?

Answer 29

Presence or absence of troponin. If present then it's an NSTEMI

Question 30

What is the second most common cause of death in car crashes

Answer 30

Aortic rupture - Typically at weaker points in aorta where the pulmonary artery is tethered by the ligamentum arteriosum

Question 31

What is the most common cause of arrhytmias & what do the other factors have in common

Answer 31

Ischemic heart disease/CAD Almost any structural alteration can result in a conduction abnormality

Question 32

What is it called when the SA node is unable to generate a high enough heart rate commensurate with physiologic needs leading to symptomatic bradycardia

Answer 32

Sick sinus syndrome

Question 33

What is the etiology of Atrial fibrillation & what are it's risk

Answer 33

Independent and sporadic depolarization of myocytes with variable transmission to the AV node. This leads to a irregular contractile pattern. The ineffective pumping of blood causes stasis which can lead to clotting and thrombus formation

Question 34

What is the most common cause of sudden death after exertion

Answer 34

Long QT syndrome --> Torsades de pointes

Question 35

What is the most common cause of sudden death due to ischemia induced arrhythmia & what are the risk factors in younger patients?

Answer 35

Coronary artery disease - Drug abuse (cocaine, methamphetamine) - Hereditary conduction abnormalities - Hypertrophic or dilated cardiomyopathy - Myocardial hypertrophy - Myocarditis - Mitral valve prolapse

Question 36

Distinguish between systolic and diastolic dysfunction

Answer 36

systolic dysfunction - Increased oxygen demand | Diastolic dysfunction - Inability to relax heart muscles

Question 37

Systolic dysfunction leading to heart failure has to do with what?

Answer 37

Lack of pumping ability leading to decreased ejection fraction

Question 38

What are some causes of systolic heart failure

Answer 38

1. Ischemic heart disease - Decreased cardiomyocytes causes the heart to not be able to pump as strongly 2. Hypertension & Aortic stenosis - Ischemic changes can cause the pump to not be functionally as effective against increased pressure over the long term 3. Dilated cardiomyopathy - Ventricles are too dilated to pump well 4. Severe mitral regurgitation

Question 39

Diastolic dysfunction leading to heart failure has to do with what?

Answer 39

Heart cannot adequately fill but ejection fraction can be normal - less filling means less blood being expelled

Question 40

What are some causes of diastolic heart failure

Answer 40

1. Hypertension & Aortic stenosis - Concentric L. ventricular hypertrophy decreasing ventricular space 2. Hypertrophic cardiomyopathy - Decreases ventricular space 3. Restrictive cardiomyopathy (fibrosis) - Decreases compliance of cardiac muscles

Question 41

What are the clinical manifestations of Left heart failure

Answer 41

1. Decreases tissue perfusion --> Decreased cerebral & renal perfusion 2. Pulmonary congestion/edema - cough, crackles, wheezes, tachypnea 3. Orthopnea 4. Tachycardia 5. Exertional dyspnea 6. Cyanosis 7. Paraoxysmal Nocturnal dyspnea

Question 42

What is the classic chest x-ray image finding & histologic sign for L. CHF

Answer 42

Kerley B lines on X-ray Hemosiderin-laden macrophages (due to extravasated RBCs)

Question 43

What are the causes of R. heart failure

Answer 43

1. Left heart failure | 2. Cor pulmonale (lung disease/dysfunction) - any cause of pulmonary hypertension

Question 44

What are the clinical manifestations of R. heart failure

Answer 44

- Liver & splenic congestion --> hepatosplenomegaly - Distended juglar veins - Effusions - peritonel, pleural & pericardial spaces - Edema - Extertional dyspnea